Researchers at the University of Colorado Boulder have discovered a brain signature that identifies fibromyalgia (FM) patients with 93 percent accuracy. The discovery opens possibilities for improved fibromyalgia diagnosis and treatments in the future.

The report, “Towards a neurophysiological signature for fibromyalgia,” was published in the journal Pain.
Fibromyalgia (FM) is a condition characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. Patients with FM show enhanced reaction to painful and non-painful sensations that are accompanied by altered neural responses.

Using functional magnetic resonance imaging (fMRI), the researchers performed brain scans on 37 FM patients and 35 healthy controls. All subjects were exposed to painful pressure and non-painful visual, auditory, and tactile cues during the scans.

Computerized machine-learning techniques allowed the researchers to identify a brain-based FM signature. Specifically, when exposed to the same painful stimuli as people in the healthy control group, FM patients showed greater neurologic pain signature responses. The method relies on a computer algorithm developed by CU Bolder researchers to recognize a complex pattern of neuronal activation in the brains of subjects exposed to pain.

Researchers found that FM patients had increased responses in three sub-markers, which correlated with hypersensitivity to pain characterized by the condition. When researchers combined the neural signature methods, they were able to classify FM patients from controls with 92 percent sensitivity and 94 percent specificity.

“The novelty of this study is that it provides potential neuroimaging-based tools that can be used with new patients to inform about the degree of certain neural pathology underlying their pain symptoms,” Marina López-Solà, a post-doctoral researcher in the university’s Cognitive and Affective Control Laboratory and the lead author of the study, said in a news release.

The tools also provided an initial characterization of individual FM patients based on pathophysiological, symptom-related brain features. Results can help physicians place patients more accurately into subtypes and provide individualized treatments.
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“Though many pain specialists have established clinical procedures for diagnosing fibromyalgia, the clinical label does not explain what is happening neurologically and it does not reflect the full individuality of patients’ suffering,” Tor Wager, director of the laboratory said. “The potential for brain measures like the ones we developed here is that they can tell us something about the particular brain abnormalities that drive an individual’s suffering. That can help us both recognize fibromyalgia for what it is – a disorder of the central nervous system – and treat it more effectively.” - shared by Fibromyalgia News Today

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But because the normalization of metabolites was not enough to successfully reduce all pain among participants of the study, researchers suggest that fibromyalgia pain results from changes in muscles and communications in the brain.

Increasing evidence from previous studies had linked brain and spinal cord neuron signaling to pain in fibromyalgia. Additionally, it has been suggested that muscles hold many factors that could potentially increase pain sensitivity, but few studies had investigated how they muscles relate to the disease.
Because exercise is reported to reduce pain in fibromyalgia, researchers at Linköping University in Sweden sought to explore molecular changes that might bring about such improvement.

The team recruited 29 women with fibromyalgia and 28 healthy volunteers. Concentrating on the participants’ largest thigh muscle, the researchers measured a range of muscle factors using a method called microdialysis, which can measure metabolite levels surrounding muscle cells.

Researchers also examined overall body measurements, blood pressure, level of psychological distress, and aspects of quality of life. Additionally, they established the number of tender points, duration of pain, pressure pain threshold, and physical capacity.

Tests at the start of the study showed that women with fibromyalgia had higher levels of glutamate (known to be involved in pain signaling), pyruvate, and lactate.

After a 15-week exercise intervention focusing on resistance training of the legs, fibromyalgia patients had significantly lower levels of the metabolites glutamate, pyruvate, and glucose in their thigh muscles than at study start. Pain intensity levels among patients had also dropped. There were no such changes in the control group.

The team found that the decreased pain intensity after the exercise intervention correlated with lower levels of pyruvate and glucose, indicating that changes in muscle metabolites likely produced the positive effects of exercise on pain.

“This study supports the suggestion that peripheral metabolic and algesic muscle alterations are present in FMS [fibromyalgia syndrome] patients and that these alterations contribute to pain. After an exercise intervention, alterations normalized, pain intensity decreased (but not abolished), and strength and endurance improved, all findings that suggest the effects of exercise are partially peripheral,” according to the report.

Because all patients still experienced pain after the intervention, the researchers believe that fibromyalgia pain may be the result of factors associated with both the brain and muscles. - Shared Fibromyalgia News Today

People with fibromyalgia and those with neuropathic pain often use similar coping strategies against pain, according to a study conducted by Danish scientists. They suggest that, for this reason, the same psychological treatment approach could be applied to both groups of patients.

Researchers, led by Dr. Lise Gormsen from the Danish Pain Research Center at Aarhus University Hospital, examined the strategies used for coping with pain by fibromyalgia and neuropathic pain patients. They asked 28 fibromyalgia patients, 30 neuropathic pain patients, and 26 pain-free volunteers to complete the Coping Strategy Questionnaire (CSQ) and rate their daily pain.

CSQ is a self-rating scale with 48 questions. It is the most widely used measure of coping with pain among clinicians and researchers. It was first validated in a group of patients with chronic low back pain, followed by other patient groups, including fibromyalgia.

Researchers found that both fibromyalgia and neuropathic pain patients used maladaptive/passive coping strategies against pain, and, surprisingly, also more adaptive/active coping strategies compared to healthy controls.

The study also showed that fibromyalgia patients who used high levels of passive strategies felt less in control of their pain that those who tended to shy away from passive strategies. This was not seen in neuropathy pain patients.

The authors concluded that, for clinical practice and especially for fibromyalgia patients, “passive coping strategies should be restructured into active ones.”
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Neuropathy pain arises as a direct consequence of an injury or a disease affecting the sensory system. It is characterized by localized hypersensitivity in and around the area of the damaged nervous system. Hypersensitivity and spontaneous pain are also seen in people with fibromyalgia, however, pain in these people is more generalized and not confined to a certain body part. - shared from Fibromyalgia News Today

Is weight creeping up on you no matter how many health-oriented ideas you try? You know that added weight causes a multitude of issues when it comes to fibromyalgia and chronic illness. Yet, no matter how hard we try, or how less we eat; we simply can't get that scale to budge. Well, there maybe an easier way that won't completely fatigue us each time we begin to exercise. That is the simple methodology of counting steps. That means we can incorporate a few more steps anytime and everywhere we have a few extra spare moments. Before you know it, you'll be increasing steps without much effort.

​Counting steps is simple. If you own a phone it may be already doing it automatically. If not, there many apps available to download such as Pacer. These apps keep record of your steps in the "background" continually allowing you to have an up-to-date number when ever you open the app. The trick is making sure you have your phone attached at all times.

If you have trouble finding your activity limits and staying within them, using a walking app or pedometer might help. These instruments give you an idea of your activity level by counting the steps you take.

A recent discussion with Dr. Charles Lapp, director of the Hunter-Hopkins Center in Charlotte shows promising health using such strategies. Dr. Lapp has treated CFS and FM patients for over 25 years and his clinic is one of the few medical practices in the United States to specialize in CFS and FM. He recommends apps and pedometers to his patients.

Dr. Lapp believes that between 1,000 and 5,000 steps a day is a good range for many people with CFS and fibromyalgia. If someone has fewer than 500 steps a day, Dr. Lapp usually suggests they gradually increase the number of steps they take.

And if someone is over 6,000 steps a day, Dr. Lapp finds they are usually too active and he advises that them to cut back. Dr. Lapp's guidelines imply that 10,000 steps a day, an exercise target often suggested for healthy people, will be inappropriate for most people with CFS and FM.

The first goal with a pedometer is to use it to determine your current activity level and its effects on your symptoms. If you wear a pedometer for several days, you should get a good idea of how many steps you are now taking per day and can correlate that with your symptom level and compare it to Dr. Lapp's suggestions.

A number of people in his program have mentioned that their initial finding was that they were too inactive. One woman thought she was making great strides by walking 2 miles a day found that just totaled a bit over 4,000 steps.

Other people feel they may be walking too much. One person said that she used her initial experience to find her limits. She said, "If I had a high number [of steps], it matched the overexertion levels and how awful I felt that night and the next few days." She discovered that initially she could walk only a few hundred steps a day without intensifying her symptoms, though she was gradually able to expand that to about 2,000.

Some people are surprised at how many steps they take, even without an exercise program. One wrote, "What astonished me was that even on days when I didn't go out [of the house], I was still recording 1,500 to 2,000 steps. No wonder I get tired sometimes and don't think that I have done anything during the day to justify the fatigue! I had no idea how much walking I did"

Once you have found your current limits, you can use the pedometer to help you stay within them and escape the cycle of push and crash: doing more when symptoms are low and paying for it with time in bed. As one person says, "There are many days I feel I can do more, but if I do I crash and burn. [My pedometer] is a wonderful device for reminding me how much I have done and how much I have left in my energy envelope for that day."

Over time, it may be possible to expand the number of steps you can take without increasing your symptoms. There seem to be two keys to safely increasing steps per day. The first is to increase gradually, which might mean no more than 5% at a time. (For example, from 1,000 to 1,050 steps per day.)

The second is to increase only as tolerated by the body. This means that you monitor the consequences of any increase and return to your previous level if symptoms are intensified.

People in this type of program have suggested two additional strategies that may be helpful if you want to increase the number of steps you do in a day. The first is to be attentive to the pace or intensity of their walking. Another said she had learned to "stroll" rather than "march."
A second strategy is to combine walking and rest. One person says that "it took many, many months of walking very short distances before I could do a great deal. I used a folding stool and/or sat at intervals on benches. This care prevented me from becoming symptomatic." Another, who had been advised to walk 30 minutes per session, broke up her walking into two or three periods of 10 to 15 minutes each. Remember those steps add up!

There may be a limit on the number of steps you can take without increasing symptoms. One person reported who had moved from about 500 steps a day to 2,000, says "I am working on increasing it, but I will be happy with that number if that's not possible."

Although pedometers can be very useful, they cannot give you a complete picture of your limits. Activity includes mental work and socializing as well as physical activity. Also, symptoms are affected by other factors such as stress, sleep, weather, food, and medical conditions you may have in addition to CFS and FM.

That said, a pedometer or walking app can be a valuable tool. Summarizing the benefits, one person noted, "Using my walking app has helped me stay within my projected weight range."

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